Do penalties for smokers and the obese make sense?

[Ratickle]

This should become an interesting debate in a few months leading up to the increase allowed in premiums......


Some say smokers and overeaters cost society more in health care costs, while others argue that they actually save taxpayers money by dying earlier.


NEW YORK — Faced with the high cost of caring for smokers and overeaters, experts say society must grapple with a blunt question: Instead of trying to penalize them and change their ways, why not just let these health sinners die?

Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong lives, including surgery, chemotherapy and other measures.

But despite these rescue attempts, smokers tend to die 10 years earlier on average, and the obese die five to 12 years prematurely, according to various researchers' estimates.

And attempts to curb smoking and unhealthy eating frequently lead to backlash: Witness the current legal tussle over New York City's first-of-its-kind limits on the size of sugary beverages and the vicious fight last year in California over a ballot proposal to add a $1-per-pack cigarette tax, which was ultimately defeated.

"This is my life. I should be able to do what I want," said Sebastian Lopez, a college student from Queens, speaking last September when the New York City Board of Health approved the soda size rules.

Critics also contend that tobacco- and calorie-control measures place a disproportionately heavy burden on poor people. That's because they:

— Smoke more than the rich, and have higher obesity rates.

— Have less money so sales taxes hit them harder. One study last year found poor, nicotine-dependent smokers in New York — a state with very high cigarette taxes — spent as much as a quarter of their entire income on smokes.

— Are less likely to have a car to shop elsewhere if the corner bodega or convenience store stops stocking their vices.

Critics call these approaches unfair, and believe they have only a marginal effect. "Ultimately these things are weak tea," said Dr. Scott Gottlieb, a physician and fellow at the right-of-center think tank, the American Enterprise Institute.

Gottlieb's view is debatable. There are plenty of public health researchers that can show smoking control measures have brought down smoking rates and who will argue that smoking taxes are not regressive so long as money is earmarked for programs that help poor people quit smoking.

And debate they will. There always seems to be a fight whenever this kind of public health legislation comes up. And it's a fight that can go in all sorts of directions. For example, some studies even suggest that because smokers and obese people die sooner, they may actually cost society less than healthy people who live much longer and develop chronic conditions like Alzheimer's disease.

So let's return to the original question: Why provoke a backlash? If 1 in 5 U.S. adults smoke, and 1 in 3 are obese, why not just get off their backs and let them go on with their (probably shortened) lives?

Because it's not just about them, say some health economists, bioethicists and public health researchers.

"Your freedom is likely to be someone else's harm," said Daniel Callahan, senior research scholar at a bioethics think-tank, the Hastings Center.

Smoking has the most obvious impact. Studies have increasingly shown harm to nonsmokers who are unlucky enough to work or live around heavy smokers. And several studies have shown heart attacks and asthma attack rates fell in counties or cities that adopted big smoking bans.

"When you ban smoking in public places, you're protecting everyone's health, including and especially the nonsmoker," said S. Jay Olshansky, a professor at the University of Illinois-Chicago's School of Public Health.

It can be harder to make the same argument about soda-size restrictions or other legislative attempts to discourage excessive calorie consumption, Olshansky added.

"When you eat yourself to death, you're pretty much just harming yourself," he said.

But that viewpoint doesn't factor in the burden to everyone else of paying for the diabetes care, heart surgeries and other medical expenses incurred by obese people, noted John Cawley, a health economist at Cornell University.

"If I'm obese, the health care costs are not totally borne by me. They're borne by other people in my health insurance plan and — when I'm older — by Medicare," Cawley said.

From an economist's perspective, there would be less reason to grouse about unhealthy behaviors by smokers, obese people, motorcycle riders who eschew helmets and other health sinners if they agreed to pay the financial price for their choices.

That's the rationale for a provision in the Affordable Care Act — "Obamacare" to its detractors — that starting next year allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums. A 60-year-old could wind up paying nearly $5,100 on top of premiums.

The new law doesn't allow insurers to charge more for people who are overweight, however.

It's tricky to play the insurance game with overweight people, because science is still sorting things out. While obesity is clearly linked with serious health problems and early death, the evidence is not as clear about people who are just overweight.

That said, public health officials shouldn't shy away from tough anti-obesity efforts, said Callahan, the bioethicist. Callahan caused a public stir this week with a paper that called for a more aggressive public health campaign that tries to shame and stigmatize overeaters the way past public health campaigns have shamed and stigmatized smokers.

National obesity rates are essentially static, and public health campaigns that gently try to educate people about the benefits of exercise and healthy eating just aren't working, Callahan argued. We need to get obese people to change their behavior. If they are angry or hurt by it, so be it, he said.

"Emotions are what really count in this world," he said.

[old377guy]

I agree with the premise only framed from the other direction. I lean towards a reward system (less premium) for folks that have verifiably improved their health along disease risk reduction lines.This may very well involve looking at some critical SNP markers for benchmarking. I say this because it's only fair that someone should make improvements in accordance with their genetic predisposition or capacity to optimize their health state.

[poncho]

Here our government insurance will pay for stop smoking aids.

[Ratickle]

I'm a bit under the thought that if you get a smoking or obesity related disease, pay for it yourself or too bad........



I have a problem with being told I have to pay for that type of an issue for someone else when I'm not the one who forced them to make that decision.....

[Buoy]

I'm a bit under the thought that if you get a smoking or obesity related disease, pay for it yourself or too bad........



I have a problem with being told I have to pay for that type of an issue for someone else when I'm not the one who forced them to make that decision.....

You're starting up a very slippery slope there Paul.
The fact that I smoke had nothing to do with my issue, but you're opening the argument that it is the cause.

What's next? Heredity and genetics testing? Family history?

Very fine lines here.

[Ratickle]

I know, but where do you draw the line? Should I pay for a smoker to replace a lung, or an obese person to have a kidney transplant? Should it be okay then to pay for the herion addict to get a heart transplant or the alcholic to have a liver transplant?

I think these are all lifestyle choices that are what they are. Just as if I crash in a boat race I don't expect you to pick up the tab for an artificial leg. I pay for that insurance myself. And, if I can't afford it that new leg or the insurance to cover that possibility, then I need to carve my own wooden one, right?

[Buoy]

But that's just it, who decides, and under what parameters is it determined that (ie) smoking is the cause?
Just like I don't agree with the fact that you could be sitting still at a stoplight and get rear ended, but if you had two beers, it's your fault.

Your boat racing analogy doesn't really fit into this discussion.
Completely different situation.
Now, if you had a heart attack or stroke while racing...
Did the rush of racing (your decision) cause it, or was it due to something else and it just occurred while you were racing??
Fine lines.

[poncho]

I smoke and it was a dumb choice. Here we have government health insurance that I pay monthly premiums for, albeit only $68.50 per month. The rest comes out of my taxes and also pay those. So if I get a smoking related illness, I've all ready paid for my treatment in monthly premiums and taxes, bith income and sin on each pack of smokes I've bought. I wouldn't feel guilty getting treatments, etc on health coverage I'm paying for.

[Ratickle]

Now I consider that a very good point. The same argument would also work for alcohol......



So just add the same porportional tax on 32oz colas, big mac's and candy bars and we're good to go......

[Buoy]

I'm a bit under the thought that if you get a smoking or obesity related disease, pay for it yourself or too bad........



I have a problem with being told I have to pay for that type of an issue for someone else when I'm not the one who forced them to make that decision.....

Our health ins is over $300/mos, not including what the co. Pays in.
It's very good ins.

The thing is, we're discussing this on a boat board. Just to be a part of this hobby, you must be at least mid to upper middle class.

The people we are discussing that would be affected are the people that are trading food stamps for $0.50 on the dollar to buy smokes and booze, and are living on welfare.
There is a class separation. But, it is by choice. I chose not to live on welfare, and that affords me to also make the decision to have a smoke or a few beers.

[phragle]

1. Evil thrill seeking powerboaters, they hit waves wrong, bounce around in the cockpit and hurt themselves or worse yet get thrpown out and nearly drown. Surely it is their choice to put themselves at risk, as well as motorcycle riders, skateboarders and those damn weekend warrior tennis players with that expensive tennis elbow rehab expense.....

2. " Obese people only hurt themselves" :FALSE... Take it from an ex firefighter/medic and now a nurse. MY BACK IS SHOT! My knees ache...I have carried too many 400~600 pound people in my time. When your 500+ pounds and you sh!t yourself in the hospital because you cant support your own weight to get to the bathroom, who's body suffers trying to clean you up??

[Ratickle]

All of those things are why this will be an interesting debate. The additional charges for smokers go into effect beginning next year. But, as Poncho points out, they've already paid an additional expense to the government in the form of taxes on every pack used (I smoked for almost 30 years, quit about 8 years ago).....

As for the dang boaters, skateboarders, etc., we also have to carry additional insurance to cover our wave hitting prowess......

[rschap1]

I don't know if I totally agree with the rationale below:

"Critics also contend that tobacco- and calorie-control measures place a disproportionately heavy burden on poor people."
Regardless of your income level, there is no forcing of anyone to smoke, no gun to your head saying "EAT IT"
The statements presented supporting this are really weak:
— Smoke more than the rich, and have higher obesity rates. Maybe you/they are poor now because your income is wasted on food and smokes.
— Have less money so sales taxes hit them harder. One study last year found poor, nicotine-dependent smokers in New York — a state with very high cigarette taxes — spent as much as a quarter of their entire income on smokes.Huh? Same tax regardless of income right? So you spend 1/4 of your income smoking...should be smarter then. Smoke less, you CANNOT AFFORD IT !!! That is stupidity, no personal responsibility, poor choice!
— Are less likely to have a car to shop elsewhere if the corner bodega or convenience store stops stocking their vices.Nowhere within an accessible range to buy a single thing besides smokes and unhealty food? You have to eat enough junk to get huge because it is within reach???

Some really poor reasoning there.
Certainly a topic to be debated, but the rich/poor slant is weak.

[Bobcat]

Healthy food is as cheap...if not cheaper than junk food. I rarely eat fast food, maybe twice a year....mainly because I can buy freshly sliced Turkey in bulk(and good bread)....for the same cost of one drive through meal.

Both my parents smoked....I never did....hate the smell....I do like the occasional Cigar now and then....America.....where poor people are OBESE !

[Buoy]

Healthy food is as cheap...if not cheaper than junk food. I rarely eat fast food, maybe twice a year....mainly because I can buy freshly sliced Turkey in bulk(and good bread)....for the same cost of one drive through meal.

Both my parents smoked....I never did....hate the smell....I do like the occasional Cigar now and then....America.....where poor people are OBESE !

I haven't had fastfood in at least 6 months.
I do kind of crave an In-n-Out burger, and White Castle (which I can't get out here).
Maybe once every 6 weeks we order Chicken Wings from a local bar (best wings I've ever had), but everything else we cook at home.

disclaimer - I did have KFC last week, but again, that's a once every 2-3 month thing.

My smoking has gotten to a point that I barely smoke unless I'm having beers.

[poncho]

I eat out for all my meals, but I'm not obese. Id pay a little extra on my junk food, like tonight I'm going to McDonalds and wouldn't mind a few cents on top of my big mac combo meal.

[Offshore Ginger]

I haven't had fastfood in at least 6 months.
I do kind of crave an In-n-Out burger, and White Castle (which I can't get out here).
Maybe once every 6 weeks we order Chicken Wings from a local bar (best wings I've ever had), but everything else we cook at home.

disclaimer - I did have KFC last week, but again, that's a once every 2-3 month thing.

My smoking has gotten to a point that I barely smoke unless I'm having beers.

Its all good , and to tell you the truth , i dont smoke - never have , exercise daily walking 3 to 4 miles ,along with rideing a bike , and lifting weights , and still have a problem loosing weight even though i have tried to cut all Carbs for the last year , and Paul , seeing that you have posted this thread ...............let me ask you a question , and that is ...... if you where to look in the mirrior ,are you truly the type of person to be posting a thread of this nature because i know you are such a buff type of guy , and healthier then the rest of us ....................Ha Ha Ha considering i am 60 going on one !

[Ratickle]

I wish I were still buff.......


It's a very important discussion. Starting next year, insurance companies will be able to charge smokers up to an additional $5000 per year for health insurance. But, according to statistics, obesity related health issues cost us more than smoking related health issues. So, obese people should pay more than smokers if you follow the exact same line of logic.